Innovative Solutions to tackle undernutrition

Timed and Targeted Counselling engaging the Community Health Facilitator to address malnutrition in Bihar by World Vision India


An innovative social and behavior change communication model has been implemented by World Vision India (WVI) with the 1000 days approach in Bihar, called as Timed and Targeted Counselling (TTC) model. In this model, Community Health Facilitators (CHF) visit the homes of pregnant women and mothers with children under two years of age. They use problem and solution stories that help the family understand the barriers in adopting positive behaviors and recognize the potential solutions. There are twelve house visits by the CHF during this 1000-day window period. During the counseling, the CHF involves decision makers or influencers at home like the husband or the father of the child, mother-in-law or grandmother of the child. The innovative SBCC model Timed and Targeted Counselling engaging the Community Health Facilitators implemented by World Vision India promotes child well-being and addresses child vulnerabilities in 583 communities in 9 districts (Madhepura, Saharsa, Khagaria, Nalanda, Nawada, Muzaffarpur, Gaya, Purnia and Jamui) of Bihar, impacting 1,32,175 households with a population of 7,58,335!

 Additionally, interventions like growth monitoring, counseling, identification of Severely Acute Malnourished (SAM) children, and equipping families for effective management of malnourished children are also undertaken. As of April 2022, WVI has 474 CHFs in Bihar, who work along with the Front-Line Workers to identify, counsel, refer SAM children, and support the families. During the period January 2021- March 2022, 406 children were identified during growth monitoring and referred to Nutrition Rehabilitation Centre (NRC), most of these children were from the Dalit communities.  


On discharge from NRC, WVI provides a food basket to the family for six months so that the child does not slip back into an undernourished state.  Mothers and caretakers are linked to cooking and feeding demonstration sessions as a follow-up.

TTC proposed visits

Under this intervention, WVI touched many lives. One such life was Paridhi from Dansar, Bihar. Paridhi turned one year on 13 March 2022. She is born in the Dansar panchayat, and her father was a daily wage laborer.  She is the only child, and her mother was worried about her poor appetite and lethargy. During the home visit by CHF-Radhika Devi, it was found during the screening that Paridhi was severely malnourished. After counseling with her father and grandmother, Paridihi was referred to a nearby NRC where she was admitted on 16 Feb 2022. At the time of admission to the NRC, the child weighed around 5.75Kg. She was provided treatment as per the medical protocol for 21 days.  The NRC at Purnia provided quality service care and the child gained 1.5 Kg by 09 March 2022 and was discharged from the center. 

During her stay at NRC, the mother was counseled on appropriate child feeding practices.  The mother was happy about the timely support and counseling she received and the fast recovery of Paridhi. One-year-old Paridhi from Jalalgarh, Purnia district benefitted from TTC.